Coronavirus Thread: Worldwide Pandemic

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What do you think will happen at an 80-90% vaccination rate? Elimination? The scientific consensus is coalescing around view that COVID will not be eliminated regardless of vaccination coverage. It is preferably for people to get immunity via vaccination rather than infection, and that’s why vaccine campaign should continue to be pushed. But it’s misleading to suggest that any figure will lead to zero covid. I’m in Canada where we are near 80% vaccination in many parts of country and cases are still rising with Delta.
Who’s staying it will lead to zero cases. You and @CrimsonTider are completely misrepresenting my argument. 80-90% drastically reduces hospitalization and that’s the entire goal here. 100% would be great but humans are paste eaters and won’t do that. The goal has always been to reduce hospitalization and deaths until we get a high enough vaccination rate we have to use masks to help that goal.

Why are we even having this argument it’s dumb
 

storyteller

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None are RCTs



One of tiny numbers of RCTs on masks found the effects were inconclusive at best ACP Journals

The study was heavily scrutinized because people didn’t like the findings but there’s yet to be RCTs with larger sample sizes contradicting the results.

RCT's for masking in a public health setting sound difficult to match. The study you mention was probably scrutinized because of their own admitted limitations breh...
Limitation: Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others.

I checked for some other articles that cited this and the first one I opened included a section that blatantly points out the difficulty of conducting an RCT and mentions the RCT you're citing...

Several COVID-19 observational studies across diverse community scenarios [300309] have suggested a benefit from masks in mitigating the transmission of SARS-CoV-2. On the other hand, there are the RCTs, which are presumed to provide the highest quality data. However, RCTs can hardly capture the complexities related to viral transmission and public health interventions [452]. Furthermore, large-scale mask RCTs related to SARS-CoV-2 are difficult to conduct given practical and ethical issues (e.g., involving no-mask controls raises an ethical dilemma regarding the principle of equipoise) and the existence of alternative types of evidence. Yet, two community-based RCTs have been conducted during the COVID-19 pandemic. One is the RCT DANMASK-19 that recruited 6,024 Danish citizens to evaluate the effect of medical masks recommendation in protecting against SARS-CoV-2 infection. This study found a non-statistically significant reduction in infection in the mask group vs. the non-mask group [504] (odds ratio 0.82, 95% confidence interval [0.54–1.23]). While medical use in this study led to a ~20% personal protection from incident SARS-CoV-2 infection, the study sample size was not enough to determine statistical significance. Because of methodological limitations of this study in addition to being underpowered (e.g., individual-level randomization, low mask adherence, serological diagnosis) [505, 506], the findings do not disprove the effectiveness of community masking. The results of this study, however, may reflect the personal protective effect (not source control) of a mask recommendation in Denmark at the time (when the community incidence of infection was modest). The other mask RCT is a yet unpublished study conducted in Guinea-Bissau [507]. This cluster-RCT (which thus allows the assessment of source control) will complete enrollment of around 40,000 participants by August 2021. Of note, this community-based study aims to assess the effect of wearing locally-sewed cloth face coverings on COVID-19 severity and mortality. This study’s outcome is clinical and not based on tests (personal communication). Although it may be able to provide some clarity on the science of cloth face coverings, this study raises ethical concerns. The choice to conduct an RCT with a control group not provided with masks more than a year into a pandemic where other types of evidence suggest their effectiveness deserves scrutiny. Furthermore, while the study protocol was designed with Danish and Bissau-Guinean researchers, conducting this trial in Africa rather than Europe or North America raises potential issues of medical racism and colonialism.

I wouldn't hold my breath waiting for RCT's in the middle of all this. Not when there is a preponderance of evidence-based review on the efficacy of these measures in real-world settings...and also since respiratory viruses always see reduced transmission from mask-use. So basically, you've dismissed research that has broadly been accepted while pushing forward research that is clearly limited. You imply that it's been scrutinized because people didn't like the findings, but I could literally go right to the study itself and see limitations listed that explain the scrutiny without assuming bad faith.

Besides that, you have to contend with real life numbers which show mass transmission in countries where mask compliance is high and worn properly. Germany even distributed high quality masks to their population this past spring and numbers there are still rising as delta takes hold.

Again, there are multiple variables that impact transmission. Just because a country has a mask mandate, that doesn't mitigate all other variables. For example, Japan just had the Olympics...I'd predict a spike in numbers regardless of masking practices because of the gatherings and influx of travelers that come with it.

I again ask, what is the policy goal at play here and what are the targets? When will it be acceptable to drop mask mandates, if not when majority of population is vaccinated?

What is the policy goal? Reduced transmission...very simple, backed by research that the scientific community acknowledges as opposed to the one study you cite which even the authors acknowledge had serious limitations.

What are the targets? This would probably come down to looking at each locality that issues a mandate to see what they're setting as targets no?

When will it be acceptible to drop mask mandates? It's probably when each locality meets the targets from the previous question.

If not when a majority of population is vaccinated? Probably when there's a consensus that herd immunity has been reached or when new infections reach some benchmark low. Again, I'd look back at where the mandate comes from to see if they include targets or measures as this could change from one precinct to the next.
 

thatrapsfan

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@storyteller

I’m arguing their efficacy is exaggerated ( i.e. when old CDC director suggested it’s as effective as vaccine), when real life numbers show us Delta variant is finding its way in countries where mask wearing compliance is high and not controversial or a political wedge issue.

That there tons of variables that impact transmission should be further reason to
temper the rhetoric suggesting they can end the pandemic or even significantly reduce transmission.

Japans delta wave preceded the Olympics, and if you don’t want to rely on their experience then pick any country in SE Asia right now experiencing large delta waves.

Germany mandated medical grade masks, and got rid of cloth masks at the beginning of the year, and are also facing same trend. European countries mandate medical-grade masks over cloth face coverings

If the growing consensus that herd immunity will not be reached at all is cemented, do you think the mandates should be revisited? It is very likely the case that waves will come and go, as flu seasons do for foreseeable future. In context where majority has immunity from vaccination and or natural immunity, policy will have to evolve in recognition of that. Otherwise you’re making case that mandates should be reintroduced every single time community transmission is detected, indefinitely.
 

storyteller

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@storyteller

I’m arguing their efficacy is exaggerated ( i.e. when old CDC director suggested it’s as effective as vaccine), when real life numbers show us Delta variant is finding its way in countries where mask wearing compliance is high and not controversial or a political wedge issue.

That there tons of variables that impact transmission should be further reason to
temper the rhetoric suggesting they can end the pandemic or even significantly reduce transmission.

I can vibe with the idea that mask efficacy has been oversold to the general public. But I've always looked at these precautions as a package rather than in a vacuum. I know the comparison has gotten used to death, but traffic laws apply here. You can drive the speed limit and be less likely to die in a car crash. You can wear a seat belt and be less likely to die in a car crash. You can have an airbag in a vehicle that reduces your likelihood to die in a car crash. With any one of these, you're reducing the likelihood of dying in a crash...but you still might die. With all three stacked, you're even less likely to die in a crash...but you still might die. We mandate air bags, speed limits, and seat belts in tandem because while they're effective to varying degrees, the combination represents our greatest chance to reduce vehicular death within reason. Masks, social distancing, and vaccination each have varying degrees of efficacy, but none are catch-all solutions while combining them represents the best chance to survive...also throw in contact tracing as another precaution measure that's helpful.

Japans delta wave preceded the Olympics, and if you don’t want to rely on their experience then pick any country in SE Asia right now experiencing large delta waves.

Germany mandated medical grade masks, and got rid of cloth masks at the beginning of the year, and are also facing same trend. European countries mandate medical-grade masks over cloth face coverings
https://amp.cnn.com/cnn/2021/01/22/europe/europe-covid-medical-masks-intl/index.html

The reason I'd point to the retrospective reviews from Pubmed over these examples is that those reviews are more encompassing and at least attempt to account for all variables. We could cherry-pick some examples and say "look, the masks didn't save them" but this is clearly a much more complicated issue than "masks didn't work." The experts that compile data and review with attempts to address variables almost all come to the same conclusion which is that masks help reduce transmission; while the degree of that reduction is the only thing left to nail down. When they account for other variables, the conclusion is virtually always that where more people wear/wore masks, less people get COVID.
If the growing consensus that herd immunity will not be reached at all is cemented, do you think the mandates should be revisited? It is very likely the case that waves will come and go, as flu seasons do for foreseeable future. In context where majority has immunity from vaccination and or natural immunity, policy will have to evolve in recognition of that. Otherwise you’re making case that mandates should be reintroduced every single time community transmission is detected, indefinitely.

Is the growing consensus that herd immunity is unattainable entirely? I was under the impression that we're fighting two issues which is getting enough people vaccinated and addressing the risk of mutation; but those two challenges work off each other. With more people vaccinated, replication is reduced which also reduces mutations and the evolution of variants. Reaching herd immunity globally seems extremely daunting, and potentially we won't be able to keep up with new strains developing...but I think it's way too soon to make any grand conclusions.

The delta variant along with complacency leading to new waves has shown us that this can drag on and that strategies may need to change or evolve. But the treat COVID as an inevitability similar to the Flu doesn't seem any more realistic than chasing herd immunity when we see how exponential spread functions. At a minimum, you'd need to reduce the transmission greatly and then put heavy resources into stronger contact tracing to mitigate the dangers of hospitals being overrun and rapid spread before that even seems reasonable without acknowledging the broader implication that you're accepting the deaths of a LOT of people...also, we're talking about mask mandates at the heart of this. It's not exactly, shutting down society to have people wear masks where the risks of transmission are increased.
 

nyknick

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Biden Administration Plans Covid-19 Vaccine Boosters Starting at Six Months Instead of Eight
Pfizer, BioNTech have requested clearance for Covid-19 vaccine boosters that an official said could be administered six months after previous dose

Federal regulators are likely to approve a third Covid-19 shot for vaccinated adults starting at least six months after the second dose rather than the eight-month gap they previously announced, a person familiar with the plans said, as the Biden administration steps up preparations for delivering boosters to the public.

Data from vaccine manufacturers and other countries under review by the Food and Drug Administration is based on boosters being given at six months, the person said. The person said approval for boosters for all three Covid-19 shots being administered in the U.S.—those manufactured by Pfizer Inc. and partner BioNTech SE, Moderna Inc. and Johnson & Johnson —is expected in mid-September.

The Biden administration and companies have said that there should be enough supply for boosters. The U.S. has purchased a combined 1 billion doses from Pfizer and Moderna.

A White House spokesman declined to comment. An FDA spokeswoman declined to comment on interactions with vaccine manufacturers.

Pfizer and BioNTech said Wednesday that they had asked U.S. health regulators to authorize boosters of their Covid-19 vaccine and submitted additional data showing a third dose improves protection against the virus. The FDA granted full approval to the vaccine on Monday. Biden administration officials have said they hope full approval will encourage more people to get vaccinated, pushing up inoculation rates that recently climbed past 60% of the eligible U.S. population.

Pfizer said it couldn’t comment on potential regulatory decisions. Moderna said Wednesday that it had completed filing for full approval of its vaccine, which uses similar mRNA technology as the Pfizer-BioNTech shot. Full approval of Moderna’s vaccine is expected in about three months, the person familiar with the matter said. Johnson & Johnson has said it plans to file for approval later this year.

Federal officials last week recommended that adults who received a two-dose regimen of mRNA vaccines such as Pfizer’s begin receiving booster shots in September. Officials said at the time that the shots would be administered about eight months after the second dose for people ages 18 and older. Boosters will be administered at the 80,000 pharmacies and other vaccination sites operating across the U.S.

The effort hinges on FDA clearance of the additional shots, and a recommendation by a vaccine advisory committee of outside experts to the Centers for Disease Control and Prevention. The CDC sets recommendations on who gets priority for the vaccines and when.

Health authorities already have authorized booster shots for people 12 years old and above whose immune systems are compromised. People 65 and older and individuals in chronic-care facilities are expected to get boosters first, along with health workers and anyone else who was vaccinated earliest, according to federal health officials.

Some public-health experts have said boosters aren’t necessary based on data that shows ongoing protection against hospitalizations and death from the initial round of shots. Vin Gupta, health adviser to the Biden administration’s postelection transition team, said he believes boosters should be reserved for people with compromised immune systems, older people and people with comorbidities such as diabetes. “I don’t think there’s any compelling data for boosters for everyone at eight months,” Dr. Gupta said.

Leana Wen, health policy professor at George Washington University, said approving boosters starting at six months after a previous dose makes sense based on available data on waning immunity. “That doesn’t mean every patient needs to get a booster at six months,” she said.

Studies indicate the Pfizer-BioNTech vaccine is still highly effective in people six months after their second dose. Yet there is some evidence its efficacy might diminish over longer periods and the shot isn’t as effective against the contagious Delta variant, prompting research into adding a third dose.
Pfizer and BioNTech said Wednesday that the third dose generated a stronger immune system against the original Covid-19 strain compared with the original two-dose course.

The submission includes data from a late-stage trial of 306 subjects between 18 and 55 years who received a third dose between 4.8 and eight months after completing the two-dose course of vaccination, Pfizer said. Neutralizing antibodies—which play a key role in the immune system—were more than three times as much when measured one month after the third dose, compared with one month after the second dose.
The administration of a third dose also appeared safe in the trial, the companies said.

The companies didn’t say whether the data included how well a booster shot worked against the contagious Delta variant. However, the companies earlier this month had submitted to regulators separate results from a small, early-stage study showing a third dose of their vaccine generated higher levels of neutralizing antibodies against the original virus and against the Beta and Delta variants than the standard two-dose regimen.

Other vaccine makers also are studying whether booster doses could help maintain protection against the virus. On Wednesday, Johnson & Johnson said that a second dose of its vaccine was found in a study to generate a strong immune response, justifying a booster shot.
Write to Stephanie Armour at stephanie.armour@wsj.com and Jared S. Hopkins at jared.hopkins@wsj.com
 

TheDarceKnight

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For me the conversation has been muddled in two directions. By the anti crowd one side, but also by people strongly supportive of NPIs like masks and restrictions, and exaggerating their utility. I’m sure you’ve heard people say COVID situation wouldnt be so bad if only people wore their masks and followed rules.

Policy also doesn’t exist in a vacuum. It made sense to have some measures, rather than nothing at all, when we had no vaccines. But situation is different in places that have mass vaccination. It seems like people are still under the impression elimination is in sight, but there’s a scientific consensus now that it’ll never happen. Given that reality, is the idea we will continue to advocate measures like masking and social distance indefinitely? Even with mass vaccination? There is no point where COVID will stop circulating, so policy should evolve in recognition of that.
I tried to answer this a little bit, but I don’t think we’re close to being able to answer this when our healthcare and frontline workers are overwhelmed and fatigued every single day. When our hospitals are consistently not being overrun then we can start to think about going back to a maskless world. Until then it’s a minor inconvenience to help some of the most important members of our society (doctors, nurses, etc)


Who’s staying it will lead to zero cases. You and @CrimsonTider are completely misrepresenting my argument. 80-90% drastically reduces hospitalization and that’s the entire goal here. 100% would be great but humans are paste eaters and won’t do that. The goal has always been to reduce hospitalization and deaths until we get a high enough vaccination rate we have to use masks to help that goal.

Why are we even having this argument it’s dumb
Exactly!
 
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nyknick

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U.S. data show rising 'breakthrough' infections among fully vaccinated

CHICAGO, Aug 24 (Reuters) - Some 25% of SARS-CoV-2 infections among Los Angeles County residents occurred in fully vaccinated residents from May through July 25, a period that includes the impact of the highly transmissible Delta variant, U.S. officials reported on Tuesday.

The data, published in the U.S. Centers for Disease Control and Prevention's weekly report on death and disease, shows an increase in so-called "breakthrough" infections among fully vaccinated individuals.

The CDC is relying on data from cohorts, such as the Los Angeles County study, to determine whether Americans need a third dose of COVID-19 vaccines to increase protection. Government scientists last week laid out a strategy for booster doses beginning on Sept. 20, pending reviews from the U.S. Food and Drug Administration and the CDC. read more

The new data released on Tuesday involved more than 43,000 reported infections among Los Angeles County residents aged 16 and older. Of them, 10,895, or 25.3%, occurred in fully vaccinated persons, 1,431, or 3.3%, were in partially vaccinated persons, and 30,801, or 71.4%, were in unvaccinated individuals.


The vaccines did, however, protect individuals from more severe cases. According to the study, 3.2% of fully vaccinated individuals who were infected with the virus were hospitalized, just 0.5% were admitted to an intensive care unit and 0.2% were placed on a ventilator.

Among the unvaccinated who fell ill, 7.5% were hospitalized, 1.5% were admitted to an intensive care unit and 0.5% required breathing support with a mechanical ventilator.

In addition to the LA County data, the CDC on Tuesday released an update on the HEROES cohort study among healthcare workers that showed a significant drop in vaccine effectiveness among vaccinated frontline workers in eight states who became infected with the coronavirus.

Vaccine efficacy during the period of the study when Delta was predominant fell to 66% from 91% prior to the arrival of the Delta variant, according to the report.


(This Aug. 24 story corrects figures in 5th paragraph to read: 0.5% admitted to intensive care, from 0.05%; and to 0.2% placed on a ventilator from 0.25%)

Reporting by Julie Steenhuysen, Editing by Mark Porter
Our Standards: The Thomson Reuters Trust Principles.
When you take into account that LA County is around 65% fully vaccinated and around 25% unvaccinated, numbers look pretty good. Although May through July still might be a bit too early to get full picture of delta's impact.
 
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